How to Boundary-Set and Cope with Elderly Family Member Turning Abusive
August 13, 2019 12:14 AM   Subscribe

This isn't a new problem but it's new to us, and I need pointers. My elderly father has begun to more and more frequently express his anger and other negative feelings in inappropriate ways, and help is needed for best practices in boundary-setting and coping in a situation where we can't simply DTFMA.

My father is in his early eighties. He has emotional and mental issues which have begun to badly affect his relationship with his family. He characterizes an yelling, angry outburst -- which happens whenever he is ashamed, angry, etc. -- as merely an expression of annoyance. (That is not an age-related issue, as it's always been this way.)

As he is aging, I believe he feels more shame over various things (memory loss, infirmities, etc.), but he is expressing them in a abusive way. In disagreements, he won't engage in calm problem-solving but merely coldly withdraws himself from the situation, even with his immediate family.

He is not physically abusive. He might be called verbally abusive but in many ways is not: he seems to express shame, confusion and other negative emotions solely through explosive, angry outbursts he then immediately characterizes as not-an-outburst. But he is also frequently loving and there is no doubt he cares, as expressed through many different ways. We are not talking about the kind of personality of the sociopath abuser, who does loving things to make sure he can continue to abuse.

He is almost certainly not willing to go through a cognitive exam, and thus far will not be counseled by either his minister or a therapist. He does have a primary care physician. It occurs to me as I write this that the problem might potentially be neurological, based on his medical history, and I'll bring that up to my mother.

Were I reading this from someone else, my initial reaction would be very binary: cut this person out of your life. The problem is that's just not going to happen. No one around him is going to willingly leave him.

When someone like this must remain in your life:

First, if the goal is to keep some sort of calm sanity and love, where do you lay the boundaries down (on which lines, which behaviors)? What things is it reasonable to say "I will not let this be violated"? And how do you communicate them to someone in this sort of situation?

Second, what other advice do you have for coping with or adjusting to this kind of a situation?

For both of the above, I ask for answers both for me as an adult child who visits and communicates with him, but also for how I might advise my mother. Advice, or books, or linkage are all welcomed.

(Despite all of the above, he is not a monster. Please do not see him that way. He is a good dad and I am trying to finally just give up on anything that might cure, and instead find protective routines where we can all co-exist as peacefully as possible, since restoration won't be possible.)
posted by anonymous to Human Relations (9 answers total) 5 users marked this as a favorite
The combination of age, memory loss, and personality change makes me think that yes, this may be neurological. The early stages of various dementias can present this way, and many people in their eighties are cognitively impaired. I’d suggest looking for a chapter of the Alzheimer’s Association local to you - they may have advice (even if it isn’t Alzheimer’s per se).
posted by eirias at 12:21 AM on August 13 [10 favorites]

I agree that it sounds potentially neurological, but regardless I think the key here is that you can’t realistically expect him to change his behavior: it’s very possible that he can’t help it. But you still need to protect yourself! So boundaries needs to be something you can do on your own or with the cooperation of people other than your father.

Do you and your mother have a way to leave the situation (temporarily) that’s safe for everyone, including your father? That’s one way you can enforce a boundary. Can you make sure that you have a buddy (either “on the ground” when you’re dealing with your father or someone you can debrief with afterwards)?

Also you probably just need to expect less of your father. He’s not going to engage in calm problem-solving. Can you help to arrange his life so that he is triggered less often? I know this sounds a lot like walking on eggshells around an abuser, and of course it’s not *fair*, but it might be the easiest way to preserve a relationship with him, because people in their 80s with lifelong mental and emotional problems don’t usually get better.
posted by mskyle at 4:33 AM on August 13 [2 favorites]

I'm not sure that framing this as "turning abusive" is useful. I think you need to consult with your family physician because "suffering from memory disease __________" is probably a more accurate and helpful way to view this change of circumstance. What you are describing is common, and a common way people discover that their parents or partners are facing dementia.

Boundaries when dealing with someone who has a disease that results in behaviors they cannot control are almost all around physical safety. The rest is coping mechanisms. There are so many resources and training videos and books to help you and your family when you have a diagnosis and know what it is you are actually dealing with.
posted by DarlingBri at 5:44 AM on August 13 [6 favorites]

Lack of inhibition and anger can be a sign of dementia and/or depression in the elderly. A GP is a good place to start but you might get more from a neuro assessment.
posted by Riverine at 6:52 AM on August 13

In the short term, I suggest withdrawing from his presence when his behaviour is problematic. Just say, "Dad, I love you, but I can't be around you when you're like this. I'll come back later." No debate allowed, just leave no matter what he says in response. And go do something else.
posted by seanmpuckett at 7:08 AM on August 13 [6 favorites]

I'm sorry you are going through this. One thing you might check: his hearing. We had an elderly relative who became extremely difficult/combative and it turned out that his inability to clearly understand conversations was making him frustrated and triggering explosive episodes. Good hearing aids improved the situation immensely.
posted by apparently at 7:31 AM on August 13

This is hard, because very often the behavior IS unpleasant and maybe even intended to manipulate or misdirect, but "boundaries" in the way we would use the methodology with a more or less competent person isn't really a thing that works when there's cognitive deficit AND confusion/memory loss/memory permanence issues.

It is a real likelihood that you are dealing with at least partially-untreatable progressive decline of old age, and I think that the narrative you're running in your own head matters as far as how you perceive the behavior. Which is not to say you shouldn't take care of yourself and your feelings - and there are some resources out there for caretakers of people with dementia/Alzheimers/severe TBI, though it's not prioritized because those caretakers are often women - but also, in the face of his bullshit, you may want to change your narrative from "he is abusive" to "he can't control himself, what tools do I have to steer this situation to a more palatable place?" Cognitive dysfunction is not invisible to the person experiencing it, it's like living in a haunted house, and it causes immense anxiety and fear, which are not great for a person's demeanor.

If you could get him in to see his doctor, there probably are some things you can do that might help, definitely even things like hearing aids and appropriate pain management if he has chronic/frequent joint or soft-tissue pain. In my experience with stubborn-ass elder care, sometimes doctors will proscribe anxiolytics or antidepressants off-label to "improve appetite" and "help manage blood pressure" (because they do do those things too).

This won't be the first time his GP has had to help a family tread these waters, and a good GP is really good at giving perfectly sound reasons for referrals, along with the fact that a lot of people will listen/believe non-family over family, it's just a human thing. It may help if you prepare a written outline of your observations and see if you can provide them to the office in advance so the doctor can review before examining your father, so that you don't have to agitate him by saying it in front of him, which is a little bit unfair to him but sometimes your priority will have to be "least agitation".
posted by Lyn Never at 8:14 AM on August 13 [3 favorites]

You can write to his GP with your concerns about neurological issues. They won’t be able to discuss him with you without his permission, but they can take your information on board.

With that said: with the hindsight of my own experience, I’d advise you not to pin too much hope or decision-making on getting a medical diagnosis or a specific pattern of treatment. If he really won’t engage there is very very little you can do on that front. This is a hard thing to accept, one of the hardest things in the process to get my own head round, but it is what it is. So, try, but with the knowledge that failure is one very possible outcome.

As for how to process it yourself, I have found it helps to accept both the likely physical illness or decline along with acknowledging that the person still has some agency. So, “He is behaving terribly; this is probably caused at least in part by XYZ; he is not 100% in control of how he behaves; but he is not 0% in control either, and I really wish he’d handle this some other way than raging.”

Boundaries: I don’t bother explaining mine to the person they’re about any more, that just led to pointless stress. I draw up boundaries for myself about what I will and won’t accept, and I set out for myself what I’ll do if they’re broken, which is almost always to calmly say “not staying around you when you’re like this” or just “no” and leaving. Mine are all around not staying around to be raged at, or to hear ranting about other people or specific situations he ruminates over. (Sometimes with the latter I’ll go “hmmm” and change the subject rather than end the conversation, but if it gets ragey I’m out.)

I also remind myself that boundaries are about me, they’re not a punishment or a behaviour modification tool for him. They are set not with the aim of getting him to do/not do whatever but to minimise my exposure to the behaviours I don’t like.

Sorry you’re going through this. It’s hellish.
posted by Catseye at 8:51 AM on August 13 [4 favorites]

FWIW, anger and lashing out in frustrating moments are early symptoms of dementia/Alzheimers. There’s not a lot you can do if his behavior is dementia-related, I’m afraid.
posted by Thorzdad at 2:45 PM on August 13 [1 favorite]

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